Caro JJ, Jackson J, Speckman J, Salas M, Raggio G
Compliance as a function of initial choice of antihypertensive
drug
12th Annual ASH Meeting
Am J Hypertens
(Apr) 10:141A 1997
Antihypertensive therapy is complicated by the fact that many
patients are not compliant, thus reducing the real effectiveness
of treatment.
This study was designed to determine if the choice
of initial antihypertensive agent is a determinant of compliance.
All outpatient prescriptions (over 3 million) for
antihypertensive drugs filled in the Canadian province of
Saskatchewan over a 5 year period were examined. Patients with
conditions likely to influence the choice of antihypertensive
agent were excluded.
Of the newly diagnosed patients (27,364),
41% stopped treatment during the study period. The likelihood of
non-compliance was significantly related to the drug utilized.
Compliance at the start of the fifth year was 54% for diuretics,
63% for beta-blockers, 64% for calcium blockers, and 71% for ACE
inhibitors. The percentage of patients remaining on the initial
agent at the start of the fifth year were: diuretic 19%, beta-
blocker 16%, calcium blocker 20%, ACE inhibitor 26%. These
differences remained significant after controlling for patient
characteristics, frequency of pretreatment physician visits,
hospitalizations and non-antihypertensive medications. The
authors conclude that patients are likely to be more compliant
with ACE inhibitors than with diuretics or beta blockers.
Comment: There has been recent interest in using diuretics and
beta-blockers as first line therapy because of proven efficacy
and decreased cost. This study raises the concern that decreased
patient tolerance/compliance may offset these advantages.
(David J. Leehey, M.D., Loyola University at Chicago)
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12th Annual ASH Meeting
H: Drug therapy :
Compliance
H: Drug therapy :
Chronotherapeutics